‘Oh God,not a Palliative’: out-of-hours general practitioners within the domain of palliative care

Abstract

To date, the experiences of out-of-hours general practitioners with regard to palliative care patients and their management are yet to be evaluated, since the new General Medical Services contract came into force. In 2007 the National Institute for Health Research highlighted the need to identify factors that improve and hinder the delivery of optimum palliative out-of-hours care. By interviewing general practitioners who work out-of-hours shifts, this project explored factors influencing confidence in dealing with symptom control and palliative care provision outside regular working hours. Face-to-face semi-structured interviews were conducted with nine out-of-hours general practitioners employed by Serco. Interviews were conducted by a specialist doctor in palliative care who had in the past worked as an out-of-hours general practitioner. Interviews were analysed using Interpretative Phenomenological Analysis. General practitioners expressed concerns relating to constraints within the system provided by the private company-owned out-of-hours provider. Data from interviews was thematically very rich and brought out many different subject areas, some similar to previous interviews, some different. Sub-themes related to the process-driven aspects of working in out-of-hours:

• Motivation

• Time-pressure constraints and continuity

• The out-of-hours doctor within the domain of palliative care

• Isolation within system

General practitioners stated that their motivation was mainly financial. There was clear concern about the lack of continuity, and inadequacy of notes and follow-up, and there was a demonstrated need for more learning on the topic of palliative care. Pressure from the out-of-hours provider to see more patients was felt to be oppositional with the need to spend adequate time with this vulnerable patient group. General practitioners felt as unwanted strangers who were viewed with suspicion by patients and carers in palliative care situations. It was clear that most of the doctors interviewed felt a strong sense of isolation when working out-of-hours shifts, and some felt less inclined to contact specialist palliative care services.

Keywords

After hours interpretative phenomenological analysis isolated working new GMS contract out-of-hours palliative

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References

Worth A. , Boyd K. , Kendall M. , et al. Out-of-hours palliative care: a qualitative study of cancer patients, carers and professionals. Br J Gen Pract 2006; 56: 6-13.

Scott A. , Watson MS , Ross S. Eliciting preferences of the community for out of hours care provided by general practitioners: a stated preference discrete choice experiment. Soc Sci Med 2003; 56: 803-814.

Thomas K. Out-of-hours palliative care - bridging the gap. Eur J Palliat Care 2000; 7: 22-25.

Shipman C. , Addington-Hall J. , Barclay S. , et al. Providing palliative care in primary care: how satisfied are GPs and district nurses with current out-of-hours arrangements? Br J Gen Pract 2000; 50: 477-478.

Higginson I. Care provided by generalists at the end of life: scoping exercise on research priorities. Service Delivery and Organisation Programme, National Institute for Health Research , 2007.

Department of Health. Investing in General Practice. The New General Medical Services Contract. London: Department of Health, 2003 .

Department of Health. Raising Standards for Patients. New Partnerships in Out-of-Hours Care. An Independent Review of GP Out-of-Hours Services in England. London: Department of Health, 2000.

Serco website http://www.serco.co.uk/markets/health/ community/index.asp (accessed September 2009).

Silverman D. Doing Qualitative Research: A Practical Handbook . London : Sage, 2005.

10.

Smith JA , Osborn M. Interpretative phenomenological analysis. Qualitative Psychology: A Practical Guide to Research Methods, 2nd ed. London: Sage Publications, 2008.

11.

Sibbald B. , Bojke C. , Gravelle H. National survey of job satisfaction and retirement intentions among general practitioners in England. Br Med J 2003; 326: 22.

12.

Whalley D. , Gravelle, Sibbald B. Effect of the new contract on GPs’ working lives and perceptions of quality of care: a longitudinal survey. Br J Gen Pract 2008; 58: 8-14.

13.

Smith JA , Flowers P. , Larkin M. Interpretative Phenomenological Analysis: Theory, Method, Research . London: Sage, 2009.

14.

BBC , Out-of-hours medical care ‘not good enough http://news.bbc.co.uk/1/hi/england/cambridgeshire/8507292.stm (accessed February 2010).

15.

Telegraph, One out of hours GP for 650,000 people http://www.telegraph.co.uk/health/healthnews/7101812/One-out-of-hours-GP-for-650000-people.html (accessed Feb 2010).

16.

Mooney H. GPs who work alone are six times more likely to come before GMC. Br Med J 2009; 339: b3036.

17.

NHS Employers. Lone working . http://www.nhsemployers.org/HealthyWorkplaces/HealthAndSafety/Pages/HealthAndSafety-Loneworking.aspx (accessed 07/12/2009).